What Else Do the Statistics From California’s Exchange Reveal?

Nearly 1.4 million people enrolled in a Covered California health plan, the state announced this week, after the open enrollment period ended Tuesday.

The big headline was that the enrollment total exceeded the state’s target. But included in the press release were statistics on who enrolled, how they enrolled and what health plan they selected.

An analysis of these statistics raises several questions:

Did enough young people enroll in Covered California? If not, will costs rise?

According to Covered California, 29 percent of enrollees were between 18 and 34 years old. But insurance industry experts have said that young people should make up 40 percent of enrollees to in order to financially balance the exchange. Younger people are typically healthier and incur fewer health costs than those who are older.

Has Obamacare increased competition among health insurers?

One of the goals of the Affordable Care Act was to increase competition in the health-insurance marketplace. But the vast majority of California enrollees chose plans offered by four major companies. More than 1.3 million enrollees — or 94 percent — chose plans from Anthem Blue Cross of California, Blue Shield of California, Health Net or Kaiser Permanente. The seven smaller insurers that offered plans on the exchange captured just a sliver of the market.

Will enrollees with bronze plans experience difficulty paying for care, particularly if they have an unexpected health problem?

Slightly more than a quarter of enrollees chose a bronze plan, the option that is the least expensive of the four tiers but carries the highest deductible. For those who are healthy and don’t need to see a doctor often, this may make economic sense. But if these enrollees have an unforeseen health problem, they could face thousands of dollars in out-of-pocket expenses.

Was outreach to various racial groups adequate and equivalent?

The state met all of its targets for enrolling various racial groups, including whites, Latinos, Asians and African Americans. But enrollment of Asians and whites far exceeded goals, while sign ups of Latinos and African Americans were only a few thousand above targets.

Was the enrollment process too confusing for those who started applications representing more than 1.3 million people but never finished them?

Through March 31, about 3.5 million applications for a Covered California plan or Medi-Cal had been started on the exchange website. The state estimates that these applications represent 6.3 million people seeking health coverage. But only 2.7 million of the applications, representing an estimated 5 million people, were finished. That leaves about 1.3 million people who may have tried to get insurance but failed.